Provider Demographics
NPI:1124539382
Name:CONGENIAL HEALTHCARE, LLC
Entity Type:Organization
Organization Name:CONGENIAL HEALTHCARE, LLC
Other - Org Name:FAMILY MEDICINE NORTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAOUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-536-0215
Mailing Address - Street 1:1 ROOSEVELT AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-2227
Mailing Address - Country:US
Mailing Address - Phone:978-536-0215
Mailing Address - Fax:
Practice Address - Street 1:1 ROOSEVELT AVE STE 201
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2227
Practice Address - Country:US
Practice Address - Phone:978-536-0215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONGENIAL HEALTHCARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty